43 Outcomes and potential impact of a virtual hands-on training program on MRI staging confidence and performance in rectal cancer 3 Table 2 Average diagnostic accuracy (=concordance with expert reference) and IOA for the 42 study participants before and after completion of the virtual training course. Staging variables (derived from ESGAR structured reporting templates)7 Average accuracy (min-max) IOA (Krippendorf’s alpha + 95%CI) Reference standard (i.e. results of expert reference for the 7 test cases) Pre-course Post-course Pre-course Post-course Local tumour status Morphology – shape (polypoid, annular, semi-annular) 77% (64%-98%) 77% (60%-95%) 0.64 (0.55-0.73) 0.71 (0.64-0.78) 2 polypoid, 1 annular, 2 semiannular Morphology – composition (solid, mucinous, mixed) 79% (67%-93%) 91% (79%-95%)* 0.50 (0.38-0.61) 0.75 (0.65-0.85)** 4 solid, 1 mixed Tumour length in mm (= average difference in mm compared to expert reference) 9.0 mm (0-52) 7.8 mm (0-47) 0.70 (0.69-0.72) 0.79 (0.78-0.80)** Range 15-69 mm Height / distance from anorectal junction in mm (= average difference in mm compared to expert reference) 10.5 mm (0-77) 8.1 mm (0-100) 0.43 (0.41-0.46) 0.57 (0.53-0.60)** Range 0-49 mm Response (normalized wall, fibrosis without residual mass, residual mass)^ 67% (60%-74%) 75% (69%-81%) 0.31 (0.17-0.44) 0.52 (0.42-0.62) 1 residual mass, 1 fibrosis without residual mass T-stage (T0,T1-2,T3ab, T3cd,T4a, T4b) 62% (17%-95%) 62% (29%-93%) 0.77 (0.73-0.81) 0.76 (0.73-0.79) 1 T0, 2 T1-2, 2 T3ab, 1 T3cd, 1 T4a Dichotomized T-stage (T0-T3ab, T3cd-T4b) 95% (86%-100%) 95% (74%-100%) 0.75 (0.61-0.87) 0.79 (0.66-0.91) 5 T0-T3ab, 2 T3cd-T4b Sphincter invasion (no, yes) 85% (62%-100%) 87% (64%-100%) 0.44 (0.36-0.52) 0.49 (0.41-0.56) 6 no, 1 yes Mesorectal fascia and peritoneal involvement MRF involvement (no, yes) 86% (62%-100%) 90% (57%-98%) 0.59 (0.52-0.65) 0.65 (0.59-0.70) 5 no , 2 yes Relation to peritoneal reflection (above, below, straddling) 79% (43%-95%) 85% (66%-95%) 0.26 (0.10-0.42) 0.35 (0.19-0.51) 6 below, 1 straddling
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